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48-year-old male with L upper quadrant pain for a month. Had abnormal CT, IVP, renal nuclear scan at outside facility.
CT showed large L hydronephrosis and UP junction obstruction. No lymphadenopathy.
Retrograde cystoscopy: anterior urethra WNL. Prostatic urethra showed mild BPH. Bladder negative. L retrograde ureteropyelogram revealed non-functioning L kidney with ureteropelvic junction obstruction, markedly dilated L pyelocaliceal system, longstanding hydronephrosis.
Extensive inflammation of left kidney parenchyma, kidney huge and grapefruit sized. No complications during procedure.
L kidney nephrectomy: high grade papillary urothelial carcinoma of renal pelvis w/extension through muscularis propria into peripelvic adipose tissue. Ureter margin negative. Negative involvement of adrenal, renal vein and artery. No lymph nodes identified.
Surgery: Left nephroadrenalectomy.
Radiation: Began beam radiation 3000 cGy treatment of renal bed.
Chemotherapy: Began Chemo – Gemzar, carboplatin.